摘要
目的探讨运动平板试验(TET)联合常规心电图(ECG)及动态心电图(DCG)对冠心病慢性心肌缺血的诊断价值。方法回顾性分析2017年7月至2020年6月浙江中医药大学附属第一医院收治的245例可疑冠心病慢性心肌缺血患者的临床资料,以冠脉造影(CAG)为金标准,比较TET与TET联合ECG及DCG诊断冠心病慢性心肌缺血的效能。结果245例患者CAG检查阳性135例,其中TET检查阳性86例,阴性49例;CAG检查阴性110例,其中TET检查阴性85例,阳性25例。TET与3者联合诊断冠心病慢性心肌缺血的灵敏度、特异度、准确度分别为0.637、0.773、0.698和0.607、0.891、0.735,3者联合诊断的特异度明显高于TET(P<0.05),而灵敏度比较差异无统计学意义(P>0.05)。在男性患者中,TET与3者联合诊断冠心病慢性心肌缺血的灵敏度、特异度比较,差异均无统计学意义(均P>0.05);在女性患者中,3者联合诊断冠心病慢性心肌缺血的特异度明显高于TET(P<0.05),而灵敏度比较差异无统计学意义(P>0.05)。结论TET对冠心病慢性心肌缺血有一定的诊断价值,但也存在漏诊、误诊的问题,建议临床上联合ECG及DCG,以提高诊断准确度。
Objective To investigate the diagnostic value of treadmill exercise test(TET)combined with conventional electrocardiogram(ECG)and 24-hour Holter monitoring(Holter)for chronic myocardial ischemia of coronary heart disease.Methods 245 patients with coronary heart disease in the First Affiliated Hospital of Zhejiang Chinese Medical University from July 2017 to June 2020 were enrolled in this study.Coronary angiography(CAG)was used as the gold standard to compare the diagnostic efficiency of TET and TET combined with ECG and Holter in the diagnosis of chronic myocardial ischemia in coronary heart disease.Results Among 135 patients with positive results of coronary angiography,86 patients were positive in TET test,49 patients were negative.Among the other 110 patients with negative results of coronary angiography,85 patients were negative in TET test,25 patients were positive.The sensitivity,specificity and accuracy of TET test were 63.7%,77.3%,69.8%,respectively.While those of TET combined with ECG and Holter were 60.7%,89.1%,73.5%,respectively.The specificity of combined tests was significantly higher than that of TET alone(P<0.05),but there was no significant difference in sensitivity between the two(P>0.05).In male patients,there was no significant difference in the sensitivity and specificity of TET and combined tests for diagnosing chronic myocardial ischemia in coronary heart disease(all P>0.05).In female patients,the specificity of the combined tests was significantly higher than that of TET(P<0.05),but there was no significant difference in sensitivity between the two(P>0.05).Conclusion TET has a certain diagnostic value for chronic myocardial ischemia of coronary heart disease,but it may cause misdiagnosis and missed diagnosis.Therefore,we recommend TET combined with ECG and Holter to improve the diagnostic accuracy.
作者
方静
毛威
FANG Jing;MAO Wei(Department of Electrocardiology,the First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,China)
出处
《心电与循环》
2021年第4期397-401,共5页
Journal of Electrocardiology and Circulation
基金
浙江省重点研发计划(2020C03119)。
关键词
平板运动试验
冠心病
心肌缺血
冠脉造影
动态心电图
常规心电图
Treadmill exercise test
Coronary heart disease
Myocardial ischemia
Coronary angiography 24-hour Holter monitoring
Electrocardiogram
